Enriching Medicine Through Diversity
What is the Problem?
Having a diverse physician workforce is a critical component in making health care available to those who need it most. The lack of diversity of medical students, coupled with ineffective cultural competency education, continues to produce training and treatment environments that are biased, intolerant and contributory to health disparities.
Racial and ethnic minorities comprise 26% of the total population of the United States, yet only roughly 6% of practicing physicians are Latino, African American and Native American.*
Under-represented minority (URM) faculty account for only about 4% of U.S. medical school faculty members, and approximately 20% of URM faculty is located at six schools-Howard University, Meharry Medical College, Morehouse School of Medicine, and the three Puerto Rican medical schools.*
Black physicians were found to practice in areas where the proportion of Black residents was nearly five times as high as where other physicians practice. Likewise, Hispanic physicians worked in communities with twice the proportion of Hispanic residents when compared to their non-Hispanic colleagues.*
Nearly half of patients seen by African American physicians and one-third of patients seen by Asian and Pacific Islander and Hispanic physicians are Medicaid or uninsured patients.*
URM physicians are also more likely than their non-minority counterparts to conduct research to help reduce racial disparities in health care.*
How Did We Reach This Point?
As late as 1969, minority matriculation in medical schools nationwide totaled 292, or three percent of the total number of enrollees. In 1970, the AAMC recommended that the number of medical school matriculants from URM increase to 12 percent of the total by 1975 and that a central loan program be created for URM students. By 1976, these goals had not been reached, however, enrollment of URM students had increased to nine percent. Low minority representation was perceived as an issue of equal opportunity. New minority representation issues surfaced in the 1980s when research showed that minority physicians were more likely than were their non-minority colleagues to practice in underserved areas. Attempts to increase minority representation in medical school now had two motivations: 1) equal access to education, and 2) improving health care in medically underserved areas.
There are four racial and ethnic groups defined by AAMC as under-represented minorities (URM) in medicine: African Americans, Mexican Americans, mainland Puerto Ricans, and Native Americans. In 2001, however, AAMC appointed an advisory committee to examine their definition of URM. The results of a revision of the definition could have serious repercussions for scholarship programs, recruitment efforts and academic enrichment programs. For more information on the possible revision of the URM definition, check out the AAMC website.
Affirmative Action Past and Present
In the 1978 landmark case Bakke vs. University of California-Davis School of Medicine, the Supreme Court ruled that race quotas were unconstitutional but that race may be used as a "plus-factor" in admissions as long as the policy serves a "compelling state interest" and is "narrowly tailored" to achieve that goal. But beginning in the mid-1990s, a series of lawsuits have challenged affirmative action policies and have posed a new threat to achieving diversity in medicine. In the same period, URM enrollment in medical school has seen significant decreases.
AMSA Endorses Sullivan Commission Report
The Sullivan Commission is named for Dr. Louis Sullivan, former secretary of Health and Human Services and chair of the commission. The nationlly-recognized panel issued 37 recommendations to improve diversity in the healthcare workforce. AMSA was present at the release of the findings and has enthusiastically endorsed this report as a roadmap to increased diversity in medicine.
On June 23, 2003, the U.S. Supreme Court ruled in Grutter v. Bollinger, et. al. that schools may use race in admissions decisions to support the recruitment of a diverse student body. In Gratz et al. v. Bollinger et al., the Court held that while race is one of a number of factors that can be considered in undergraduate admissions, the automatic distribution of points to students from underrepresented minority groups should not be standard, without further consideration of their other individual attributes.
Now more than ever, it is crucial to make minority enrollment in medicine a priority.
What Can We Do About It?
AMSA strives to cultivate a tolerant, accepting and culturally diverse physician workforce, which can effectively serve our multi-cultural society.
AMSA houses a wide array of resources to educate you and your colleagues about Diversity in Medicine and to equip you to make positive change for a brighter health care future through:
- Advocating for increased representation of underrepresented minorities in medicine to increase applicants and acceptances
- Educating medical students, health professionals, and the public about the relationship between diversity and disparities
- Advocating for cultural competency curricula in medical education